Unio Specialty Care – CyberKnife

Unio Specialty Care - CyberKnife, formerly CyberKnife Centers of San Diego, are proud to be the first centers in the San Diego area to offer the revolutionary technology of the CyberKnife® Stereotactic Radiosurgery System. Our programs, that work in conjunction with the services of local medical and surgical specialists, have developed a reputation for clinical excellence and compassionate care. Unio Specialty Care - CyberKnife reaffirms its commitment to superior care for our patients.

Unio Specialty Care – CyberKnife

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NEW HOPE FOR THE TREATMENT OF TUMORS
Learning that you or someone you care about has a tumor is never easy, especially if it is difficult to treat. The CyberKnife® gives patients new hope for the treatment of tumors and lesions, including certain ones that previously have been diagnosed as inoperable or untreatable with existing technology.

CONTACT US / OUR LOCATION
Our friendly staff will be happy to answer any questions you have or arrange for a consultation with one of our expert physicians to determine if CyberKnife is the right treatment option for you.

CYBERKNIFE® VIDEO TESTIMONIAL WITH DR. FULLER

CyberKnife® offers all of the advantages of radiosurgery, but without the need for a metal head frame. Instead, patients are fitted with a more comfortable flexible mesh mask for tumors in the head, or a body cradle for spinal tumors or other tumors outside the head. Because the robotic arm automatically corrects for patient movement during treatment, the CyberKnife® can be used anywhere in the body where radiation is effective.

For more than 30 years, physicians have been using stereotactic radiosurgery to destroy tumors in the brain. While the procedure does not remove a tumor, it can destroy tumor cells or stop growth of active tissue.

In stereotactic radiosurgery, high dose focused radiation beams are fired into a tumor from many angles. With older systems, such as the Gamma Knife, a metal frame is screwed into the patient’s head to immobilize the patient during treatment. Wearing this head frame is uncomfortable and limits the potential application of the Gamma Knife to single treatments, used against lesions within the brain or skull base.

A FRAMELESS ALTERNATIVE
CyberKnife® offers all of the advantages of radiosurgery, but without the need for a metal head frame. Instead, patients are fitted with a more comfortable flexible mesh mask for tumors in the head, or a body cradle for spinal tumors or other tumors outside the head. Because the robotic arm automatically corrects for patient movement during treatment, the CyberKnife® can be used anywhere in the body where radiation is effective.

CyberKnife® was developed by a team of physicians, physicists and engineers at Stanford University. The CyberKnife® technology was cleared by the FDA for intercranial applications in August 1999, and received full-body clearance in August, 2001. It has been used to treat more than 20,000 patients worldwide.

STATE-OF-THE-ART TECHNOLOGY MAKES TREATMENT COMFORTABLE AND EFFECTIVE

Treatment with CyberKnife® results in potentially fewer complications than invasive surgery and often allows patients to have a better quality of life during and after treatment.

Advantages of the CyberKnife® System include:

  • Extremely accurate radiation targeting means higher doses of radiation can be used, offering the patient a better chance for cure
  • Treats hard-to-reach tumors, many that may have been diagnosed as inoperable
  • Tumors receive radiation from many angles, minimizing damage to healthy tissue
  • Continually checks and compensates for any movement you make during treatments, ensuring accuracy
  • Requires no metal head frame or skull pins
  • Eliminates risks related to surgery, including potential infection, complication from anesthesia and post-operative bleeding
  • Requires no recovery time. Most treatments are done on an outpatient basis
  • Patients undergo their treatment and immediately resume normal daily activities
  • Reduces pain
  • Requires no or minimal sedation

STEP #1: INITIAL CONSULTATION

The initial consultation involves the radiation oncologist, a surgeon and other physicians if required. If you have a medical oncologist, we will also coordinate our plans with theirs. During your consultation, the procedure, as well as the risks and benefits, will be explained to you in detail. If treatment is to be done on soft tissue, small gold markers, known as fiducials, will need to be implanted into the tumor bearing region. Your doctor will discuss the fiducial placement procedure with you if it is a necessary part of your care.

STEP #2: TREATMENT PREPARATION

Soft Tissue Fiducial Placement

Fiducials are small gold markers that are implanted into soft tissues in or near the tumor (lesion), to accurately guide the CyberKnife® radiation beams. These markers are typically required for tumors in the chest, abdomen, pelvis or other soft tissues, while they may or may not be required for tumors in the spine and are not required for tumors in the brain or skull.

If your treatment requires the placement of fiducial markers within the tumor or lesion area, that procedure will be done by a physician or surgeon and the San Diego CyberKnife® Center staff will make the arrangements for that procedure.

  • If fiducial placement is required, there are several things that you will want to keep in mind:
    • In most cases, fiducial placement will be done as an outpatient in a radiology facility, and you will be able to return home within an hour or two.
    • Prostate fiducials will typically be placed under ultrasound guidance, either by the urologist or by the radiation oncologist.
    • Placement of CT-guided lung fiducials may require a hospital-based radiology department, because some of these placements may result in a complication known as a pneumothorax (air trapped in the space between the lung and the chest wall – sometimes referred to as a “collapsed lung”). This complication occurs in about 1/3rd of lung fiducial patients. If a pneumothorax occurs, it may be minor, requiring no further treatment, or it may require a chest tube to remove this air pocket and reexpand the lung, potentially resulting in admission to the hospital overnight.
    • Other fiducial placement methods may also be used, such as placing them through a scope that passes through the bronchus or esophagus.
    • Our doctors will prescribe the best fiducial placement method for you and our staff will make the necessary arrangements.
    • You will not be allowed to eat or drink six to 12 hours prior to the fiducial placement procedure.
    • You will need someone to drive you that day.
    • You may experience some minor discomfort after fiducial placement.

STEP #3: TREATMENT PLANNING

Making a Mask or Body Immobilizer

Prior to the treatment planning study (CT scan), the first step is to make a plastic mask (used with brain, head or neck tumors) or a comfortable foam body immobilizing system (for tumors everywhere else in the body). These devices are used to help minimize patient movement during treatment. The process is simple and painless.

STEP #4: TREATMENT PLANNING

  • CT Scan
  • The surgeon and radiation oncologist will use a CT scan to identify the exact size, shape and location of the tumor, along with the surrounding healthy tissues to be avoided.
    • The time required for this step is variable, typically lasting from several minutes to several hours, depending upon the complexity of the planning process required.
    • When scheduling this appointment, you will receive instructions regarding the CT. You may be given IV contrast (dye). Please let the staff know immediately if you are allergic to the dye.
    • This is a painless procedure. We will discuss with you the need for any pre-medication for treatment such as sedatives or pain medications. Please make us aware of any particular concerns you may have.
    • In some cases, additional radiology studies such as a MRI scan or a PET scan will also be used in the treatment planning process. If we do this, these extra scans are three dimensionally fused with the planning CT-scan to provide the most detailed map possible of your treatment area.

STEP #5: TUMOR MAPPING/COMPUTER PROGRAMMING

Once your CT studies are complete, your CyberKnife® team will review them in great detail in order to plan your treatment. Planning considerations include exact tumor or lesion configuration and its relationship to adjacent normal body structures, which in turn influences the number, intensity and direction of the radiation beams that the robotic arm will send to the tumor. This will help ensure that a sufficient dose is administered to the tumor in order to destroy it, while minimizing to the greatest degree possible, the radiation dose to the adjacent normal tissue.

When the physicians have completed their work, the physicists will finish the treatment planning. Be aware that this may take a day or longer depending upon the complexity. When the planning is complete, a date and time for treatment(s) will be scheduled. The nurse coordinator will be in touch with you during this time and will confirm with you the treatment date(s) and time(s).

STEP #6: CYBERKNIFE® TREATMENT

  • Arriving for Treatment
    • You may need to come with a family member or driver if you require sedation or relaxation for treatment. Our staff will review this with you prior to treatment.
    • Take any medications prescribed specifically for treatment according to directions on the prescription(s). You should also take your normal daily medications as usual with the exception of diuretics. Diuretics should be withheld until after treatment.
    • Wear comfortable clothing and no jewelry. A blanket will be provided for warmth if needed.
    • During treatment you will need to lay still. Generally no sedation is required because the treatment is painless, although this will be available depending upon your specific circumstance.
    • CyberKnife® treatment will be given 1-5 times depending upon your exact situation. Treatment times may vary from 30-120 minutes. We ask that you plan on spending two hours at the CyberKnife® center each day of the treatment to allow for variability of treatment time, though if more than one CyberKnife® treatment is given, this time estimate may be more exactly tuned after the first treatment.
    • You will receive written discharge instructions. Always ask questions if you do not understand a process or instructions!

The CyberKnife Treatment Process

When CyberKnife® treatment begins you will be lying on the treatment couch with your mask or body cradling system, while the imaging system acquires the first set of X-rays in the treatment position. The couch then adjusts to provide the necessary millimeter alignment, and the robotic arm then moves the linear accelerator to its first position and delivers the first treatment beam. This process is repeated many times as the X-ray system re-acquires the target and the robotic arm realigns the linear accelerator from multiple different positions – often greater than 100 times. At each angle, a precise radiation beam is delivered. The image-guidance system utilizes bony landmarks or implanted fiducial markers to track the exact location of the tumor during the entire treatment process, creating an extremely accurate and precise radiation treatment procedure.

If a lung or upper abdominal tumor is treated, the breathing cycle is also continuously tracked and correlated with tumor position, causing the robotic arm to assume a real time “breathing” pattern that tracks the tumor. This robotic breathing pattern exactly follows the tumor as it moves throughout the breathing cycle, keeping the radiation beam squarely on the tumor throughout the entire treatment.

The entire process is painless and usually lasts 30 to 120 minutes. Typically, you may return home and resume normal activities immediately following treatment. If the treatment plan calls for more than one treatment session (known as fractionated CyberKnife® treatment), the radiation therapists will schedule all of the appointment times with you.

STEP #7: FOLLOW UP

We will call you the day after treatment to see how you are doing and will arrange follow-up appointments to monitor your progress. Follow up imaging is generally performed to monitor the tumor’s response to treatment, though the exact study(ies) and their timing will vary with each situation as determined by your participating doctors. You will be given appointments to follow up with the radiation oncologist and surgeon. While waiting for your results, stay busy and maintain a positive state of mind.

 

Remember to always ask questions if you do not understand a process or instructions!

DIFFERENCES BETWEEN COMMON RADIOSURGERY TECHNOLOGIES

The most widely used radiosurgery devices include: cobalt-sourced systems (Gamma Knife), modified linear accelerators, and the CyberKnife®. All of these devices are capable of delivering the desired radiation dose to a designated target, however there can be important differences between these devices, which may have a significant impact on treatment clinical outcome
CyberKnife® Gamma Knife® Other Linac Systems (Elekta Synergy®, Novalis®, Varian Trilogy®, TomoTherapy®)
Radiosurgery Dedicated Yes Yes No
Also Does “Conventional” Radiotherapy No No Yes
Anatomic Area treatable with Radiosurgical Precision Brain, Spine, Entire Body Brain Brain +/- other selected sites depending upon specific system
Rigid Brain or Body Frame Required for Radiosurgical Accuracy No Yes Yes
Lesion Size Limitation No Yes No
Capable of divided treatments to better preserve adjacent tissues Yes No Yes
Continuously adapts to lesion motion caused by organ movement (real time lesion tracking) Yes N/A No
Continuously adapts to lesion motion caused by breathing (real time respiratory tracking) Yes N/A Varian Trilogy® uses respiratory gating but does not track with radiosurgical precision – Other systems do not adapt to breathing
CyberKnife® image-guided radiosurgery requires a multi-disciplinary team of clinicians. This may include a neurosurgeon or other surgical subspecialist, radiation oncologist, medical physicist, radiation technologist and registered nurse. Our team will work with you to provide your patient the best radiosurgery treatment available – and compassionate care. If you have questions about how CyberKnife® may benefit you, or want to arrange a consultation or referral, please call us at 858-505-4100 or 800-470-1256.

What is stereotactic radiosurgery?

Stereotactic radiosurgery is a non-surgical treatment in which high doses of focused radiation beams are delivered from multiple locations outside the body to destroy a tumor or lesion within the body. This procedure does not remove the tumor or lesion. Instead, it destroys tumor cells or stops the growth of active tissue. Traditional methods relied on a metal frame that was bolted to the skull in order to target the treatment. Because of the need for the metal frame, radiosurgery was not possible for tumors located outside of the head.

What is CyberKnife® Stereotactic Radiosurgery?

CyberKnife® is an entirely new approach to stereotactic radiosurgery because it can deliver targeted radiation to anywhere in the body, while minimizing exposure to surrounding normal tissue. It offers all of the advantages of radiosurgery, but without the need for a metal head frame. With sub-millimeter accuracy, CyberKnife® can be used to treat tumors, cancers, vascular abnormalities and functional disorders. Best of all, it achieves surgical-like outcomes without surgery or incisions.

How does the CyberKnife® system work?

Using x-ray image cameras and computer technology similar to that used for cruise missile guidance, the CyberKnife® locates the tumor in the body. The medical team then precisely defines the area to be targeted, and the structures to be protected, after which the treatment planning computer evaluates the unique shape and location of the tumor to determine exactly how each of 50 to several hundred or more beams of radiation will target the tumor. A small linear accelerator (high energy X-ray source) located on the CyberKnife’s robotic arm delivers concentrated beams of radiation to the tumor from multiple positions and angles that are selected by the computer to minimize the damage to surrounding tissues. The range of motion offered by the robotic arm gives it maximum flexibility to reach tumor sites not accessible by other means. The CyberKnife® system continually checks and compensates for any patient movement throughout the entire treatment process to ensure accuracy, maximizing the precision of the radiation treatment. Because the CyberKnife has pinpoint accuracy, it can deliver higher doses of radiation to treat tumors, ablating them as effectively as a surgeon’s scalpel, but without the incision.

How is CyberKnife® different from other stereotactic radiosurgery systems like Gamma Knife?

The CyberKnife® system uses the combination of a robotic arm, linear accelerator (high energy X-ray source), and image guidance technology. Because of the flexibility of the robotic arm, the system is able to reach areas of the body that are unreachable by other radiosurgery systems. CyberKnife® can be used anywhere in the body, while existing radiosurgery systems typically only offer treatments to the brain and skull base area. The CyberKnife® is able to locate the position of the tumor within the body without the use of an invasive head frame. It monitors and compensates for patient movement during treatment by a unique and very accurate process.

Is the CyberKnife® safe?

The CyberKnife® does not present the same problems as traditional surgery. There is no anesthesia, no incision, no bleeding and no post-operative pain or unpleasant anesthesia after effects. Because of its precision, CyberKnife® spares healthy tissue surrounding the targeted area in a manner not achievable with traditional radiation therapy. Over 20,000 people have received CyberKnife® treatments around the world.

What can I expect during CyberKnife® treatment?

Treatment follows five steps that may be performed on the same day or on separate days:
  • Initial Consultation
  • Treatment Preparation
  • Treatment Planning
    • Making a Mask or Body Immobilizer
    • CT Scan
    • Tumor Mapping/Computer Programming
  • CyberKnife Treatment
  • Follow-up
Treatment is generally completed in one to five 30 to 120 minute sessions. Patients feel no pain during the treatment and are able to go home immediately afterward. San Diego CyberKnife® staff are always present to ensure your comfort and to make sure that the treatment provides maximum benefit.

After treatment, when will my tumor or lesion disappear?

The effects of radiosurgery occur gradually over a period of time. The time frame may range from days, months or even years depending on the medical condition targeted. Some tumors resolve more slowly than others and may or may not eventually disappear completely, while others simply stop growing and present no further biologic activity. After CyberKnife® treatments patients typically have periodic follow-up imaging examinations, such as CT, MRI or PET studies, as deemed appropriate by their medical team, to assess their progress. Laboratory tests may also be ordered.

Will my hair fall out or will my skin burn after CyberKnife® treatment?

The radiation delivered by the CyberKnife® is so focused on a specific target that it is highly unlikely that hair loss or skin burn will occur. In the event that a treated lesion is very close to the scalp or skin though, the adjacent hair or skin may be affected. If so affected, this hair or skin will typically recover over time. All medical procedures, including CyberKnife® treatment, have potential side effects and associated risks, and every patient will be individually evaluated and counseled in detail before a final plan of treatment is made. Any and all questions by the patient and their family will be answered before we proceed with treatment.

Is CyberKnife® covered by insurance?

Similar to other forms of radiotherapy and surgical treatment, stereotactic radiosurgery treatments, including CyberKnife®, are usually covered by Medicare and most private insurances. However, in some instances, CyberKnife may be viewed as a “new,” “novel” or “unproven” treatment compared with existing “standard” treatments, and as such, may not be covered by insurance. If insurance denial occurs, our staff will work diligently to educate the insurance company and reverse their decision, though unfortunately, success in reversing their decision is not guaranteed.

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MR. RANDY WEAVER

Randy learned of this diagnosis when it was discovered he had two tumors. One was a life threatening brain tumor that required immediate surgery. The surgery was successful in terms of its outcome, but Randy still remembers the difficult after-effects. For the second tumor, the acoustic neuroma, he was told that there was another option that would not require invasive surgery and recovery time. The treatment would provide a much greater chance for Randy to preserve his hearing and limit the other side effects. That alternative was CyberKnife. Randy underwent CyberKnife treatment and was so impressed with the technology and his experience that he actually bought stock in the company! He was also impressed with the staff at CyberKnife Centers of San Diego and his physician, Dr. Damon Smith, who helped him work through the details of the treatment with his insurance company and made the whole experience seamless. Thanks to CyberKnife, Randy is able to hear all those things that no one should miss – his daughter’s wedding vows, the sound of his wife’s voice and his granddaughter’s laughter.

MR. DONN ROSENAUER

For ten years, Donn Rosenauer and his doctor had been monitoring a PSA level that he described as a roller coaster. But since he had no other symptoms to suggest cancer and the level of elevation wasn’t dramatic, Donn’s doctor recommend the “watchful waiting” approach – repeating tests regularly to watch for any changes.   So, when it was time to test again last year, Donn wasn’t worried. This time, however, Donn’s doctor said he had prostate cancer, and laid out the treatment options, including a standard radiation therapy – 50 treatments over a ten-week time frame. He wondered if there was a different option, one that eliminated the possible side effects of incontinence and impotence.  He had another reason for seeking a second opinion: he was scheduled to fulfill a lifelong dream with a visit to Florence, Italy in eight weeks time, and he wanted to make that trip.

That’s when he heard about CyberKnife.

“My doctor said he was impressed with the technology, and that he definitely thought I should get in touch with Dr. Fuller to see if they were still accepting patients,” remembers Donn.  “I went home and researched everything I could about CyberKnife on the Internet.  The more I read, the more excited I became, and so I was very happy when I made the call and found out that the protocol was still open and that I might qualify.” Donn then met with Dr. Fuller of CyberKnife Centers of San Diego, who had reviewed his charts and told him that he did qualify for the study.  He also outlined the CyberKnife treatment process. “I liked his ‘just the facts’ delivery,” says Donn.  “He was thorough, precise and to-the-point, which I think that anyone who is facing a cancer treatment decision can appreciate.  I had already made up my mind to follow through with CyberKnife treatment when I asked him if I should cancel my trip in June, seeing as it was now April.  His response was ‘We can do this.’ Donn underwent a course of four CyberKnife treatments that were so painless he actually fell asleep.  His only reported side effect was a slight bit of nausea the day after treatment was completed, which disappeared within 24 hours.  In June, approximately eight weeks after treatment, this seasoned traveler was in Florence, walking the city, taking in the sights and sounds and “eating the best food I’ve ever tasted in my life.”  His PSA level has fallen dramatically and is in the normal range, the lowest it has been in fifteen years. “I would encourage anyone who is facing a decision about cancer treatment to look into CyberKnife,” says Donn.  “My experience was as good as I could imagine, and everyone connected with the Center has been wonderful, from start to finish.”



MR. DOMINICK SEAVELLO

Usually, the sooner one finds cancer, the better their chances of recovery and survival.  Dominick Seavello is the exception; a year ago, the 75-year-old Escondido resident wouldn’t have been given six months to live. Seavello went to the emergency room in October when his bronchitis produced blood.  An x-ray revealed a large lung tumor; one that had been growing silently and steadily for many years.  The tumor was so large that physicians talked about taking the entire lung, but Seavello’s emphysema made that impossible.  If his diagnosis had been last May, instead of in October, his prognosis would have been very poor, due to the size and location of his tumor. Fortunately for Seavello, his cancer was discovered AFTER the physicians at CyberKnife Centers of San Diego introduced the CyberKnife to San Diego – a revolutionary new technology for treating inoperable tumors. Seavello underwent four CyberKnife treatments in December 2006, and recent follow-up PET scans show NO evidence of any tumor in his lung.  According to his radiation oncologist, Damon Smith, M.D., he is living proof of the power and promise of CyberKnife technology.

MR. EARLE GRUESKIN

Earle Grueskin, a 77-year-old retired Gateway executive who lives in Carlsbad, is another patient who is benefiting from CyberKnife treatment. Two years ago, he was diagnosed with prostate cancer, spotted when he had his annual PSA.  Like many prostate cancer patients, he had several options — almost too many, according to a recent report on MSNBC, which highlighted the confusion of multiple options for prostate cancer patients. Having already gone through a stomach resection and brain surgery in his life, Earle was ready to investigate when he heard about an alternative to traditional prostate surgery: CyberKnife. He did his homework, met with one of the physicians to ask questions and made his decision to go with CyberKnife because, as he said, “the science made sense to me.”  As the third patient of the San Diego CyberKnife Center, he is a poster child for its success:   18 months after treatment his PSA levels have fallen to near zero, his minimal side effects have resolved and there is no sign of the cancer.

MR. ROGER SMOYER

Roger Smoyer, a 74-year old retired Los Angles police officer that has lived in Ramona since 1975, found out two years ago that he had lung cancer.  Married for 52 years to a cancer survivor, he has four grown children and seven grandchildren. When Smoyer was originally diagnosed with lung cancer, doctors found it necessary to remove his entire left lung.  Unfortunately when they removed it, they found five cancerous lymph nodes in his other lung, forcing him to undergo both chemotherapy and radiation treatment. He seemed to respond to this treatment until May of this year when a PET scan showed that another tumor had developed.  This time, due to the location near his aorta, doctors told him it was inoperable.  And because he had already received his lifetime dose of radiation and chemotherapy, he felt the diagnosis was a death sentence.

That is until his oncologist referred him for CyberKnife treatment.

In June he went for three treatments over three days, which he said was a cakewalk compared to his previous treatments. Roger Smoyer just had another PET scan (in November), which shows he is now cancer free.

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